In over 30 years of attending continuing education presentations in order to, well, continue her education, Doc Righteous really thought she had seen it all. But today’s experience took the cake. She now has new things to add to her list of Things Presenters Should Never, Ever Do–and this morning’s presenter committed three of them in his first three sentences.

The Top Ten Things Presenters Should Never, Ever Do

10. Read from your notes

9. Ignore your notes

8. Digress from your notes

7. Fail to give a break halfway through, thereby denying attendees a chance to exit early and gracefully.

6. Download all your handouts directly from the public domain.

5. Put your entire presentation word for word on slides.

4. Allow attendees to ask questions throughout your presentation.

3. Announce at the outset that this is a completely new subject area for you and that you really don’t know anything about it.

2. Announce at the outset that you not only have no expertise in the subject matter at hand, but that you are counting on the very workshop attendees whom you are supposed to be instructing to help you out.

1. Announce at the outset that you are not going to talk about the very thing you were hired to talk about.

Over the years, she has acquired some Facebook friends who are not, of course, really friends. They are friends of friends, or old classmates, or simply people (suggested by Facebook’s deeply weird algorithms) who share a common interest. All told, the good doctor has about 200 “friends,” of whom she probably actually knows less than 50.

And now it is time for some serious housekeeping. Some of these people simply must go. So Doc R today began a rigorous pruning of some of the farthest-out fringe-dwellers on her Friends list.

First to go was the birther who today posted what was, for Doc R, the last straw: A photoshopped pic of President Obama resigning from office, with a really offensive tag-line to the effect that he did not deserve the job. So, off with her head!

Next was the tea-bagger who seems to believe not only that his government is hiding evidence of visitors from outer space (including, perhaps, himself? One wonders.) but also that feminist lawyers support pedophilia via the pornulating of young girls for commercial purposes. What the fuck?

Next is the pet-person who was arrested recently for hoarding animals. Doc of course understands and sympathizes with mental illnesses like this: It’s the continued cheery “collecting”–a truly unfortunate choice of words if ever there was one–of virtual animals for her virtual Facebook zoo in all this benighted person’s Updates that turns Doc R.’s stomach. Off with her head!

Facebook is supposed to be a social network, after all, not a soapbox for the most bizarre and offensive political stances that people can conjure up in the wee, sleepless hours.

Doc, not normally a patient woman under the best of circumstances, has far exceeded her limit. No more tea-baggers. No more birthers. No more of those sickening Sept. 11th conspiracy theories. You post one of those, your ass is out! Anti-Semitic? You’re history! Hate women? People of color? Gays, lesbians, bisexuals, queer, or questioning folk? transgendered or intersex persons? Buh-bye!

Here’s the thing. Dr. Righteous wasn’t even being self-righteous at the time. No, she wasn’t on her high horse about anything, wasn’t telling anyone how they should live their own lives, and damned if that’s not exactly what she’s in trouble for.

Oh, well.

Life is ironic, isn’t it?

The good Doc will probably blog it one day, in all its hairy details, but her best friend says it’s not a good idea, even anonymously. (Her best friend thinks it’s better to write a novel, and publish it under her own name. Dr. Righteous doesn’t understand that logic. But never mind.)

Briefly, Doc R. stepped on someone’s (un)ethical toes at work, entirely by accident. Now their toes are all bruised and they’re acting like it’s her fault. This is not the first time in her professional career that this has happened, but usually when she steps into the shit, it is with malice aforethought.

Once she got in trouble for calling a sexual-harasser — well , not to put too fine a point on it, a sexual harasser. She was told that was libel and she could get in trouble. She could get in trouble?? What about Sex-Boy? What about the admin for allowing a hostile work environment to persist?

On another occasion, a colleague got all pissed off at the Doc for saying, “you can’t do that” (bill one marital therapy session as two, separate individual sessions). OK, let’s rephrase that: Honey, you can do whatever you want, but it’s insurance fraud. That better?

It never ceases to amaze Dr. Righteous that people are not happy to have the error of their ways pointed out to them. Even accidentally.

Depending upon your personal situation, it may be “good”, and on your line of work. Me? I’m a psychologist in a large group practice which includes a psychiatrist whom I rather like but whose über-conservative politics drive me crazy. Oh. And did I mention? He gives paid talks for a drug company, disguised as CMEs. So Carlat’s blog post reminds me of something I prefer not to think about but which makes me sick when I do. To wit: This is, IMHO, tots unethical behavior. What can I, should I do about it? Fuck if I know.

I’m happier when Dr. Carlat refers to these guys as “hired guns” rather than the “whores” in the title, as follows:

…Schering-Plough is already poised to make aggressive use of hired guns to get psychiatrists to prescribe its new antipsychotic.

In his post, Dr. Carlat references his NYT Magazine article on his own experiences as a hired gun, which I wish were required reading at my office. I am having fantasies, as I write this, of printing off several dozen copies and putting one in every mailbox.

I asked our good doc about it casually one day and he admitted that his activities were “supported” by the drug company, that he wasn’t teaching about a disorder or even a class of medications but about one brand-name medication in particular, and that he used materials supplied by the drug company. He says he “enjoys getting out” into the countryside. Hmm. I think I see a pattern here. Do these companies target nonspecialists in rural areas in an attempt to control that market by brainwashing generalists out of the mainstream who lack the experience/training/exposure to know any better?

Here’s what Carlat says the new guys flogging Schering-Plough’s new antipsychotic will be getting paid:

–$1,600 for a 45 minute power point presentation or informal “peer discussion group.”
–$1,000 for a 45 minute web-based live presentation (you get $600 less because you don’t have to leave the comfort of your office)
–Total maximum (called “contract total aggregate”) amount that you may receive over the course of the year is $170,000.

Dang. That’s good money if you can get it. I have taught part-time at the local Cow College and I figured, by dividing all the hours I spent prepping, grading, meeting with students, and actually teaching into my salary that on an hour-for-hour basis I could make more working closing at a local burger joint. Seriously: They were hiring, and I saw the hourly wage posted on the sign. Closers make more than adjunct professors. And we have to make our own PowerPoints!

The injustice of it all.

My doc friend, on the other hand. . . well. Those are some serious bucks.

Certainly serious enough bucks to cloud his judgment, if not those of his “students”. Be interesting to know how much of the stuff he flogs gets prescribed at our practice. I know one thing: I find excuses to send my clients to other docs. I am afraid that whether it was the best drug for my client or not, he might prescribe it. And with the best of intentions! I think he honestly sees himself as an ethical physician who genuinely cares about his patients.

So whaddya think? I am tots not in a strong position here, above and beyond the psychiatrist/psychologist power differential. Should I ‘front him at a staff meeting? In private? Talk to the other docs and build up a consensus that we shouldn’t do this at this practice? Ignore it? Just start whittling away at it bit by bit, expressing a concern or two in an offhand way whenever it comes up?